Category Archives: Lorna Wing

The Autistic Maelstrom …

The_Corryvreckan_Whirlpool_-_geograph-2404815-by-Walter-Baxter

In the new, updated edition of “The Autistic Spectrum” (2002), Lorna Wing offered on page 23 a brief history of the chaos which seems to continue to this day, surrounding risen and fallen efforts to decide the main, and sub-categories of what she identified as the Autistic Spectrum. In order to justify my statement, please allow me to quote:

“The changes in ideas about autistic disorders can be seen in the history of the two international systems of classification of psychiatric and behavioural disorders. These are the International Statistical Classification of Diseases and Related Health Problems (ICD) published by the World Health Organisation, and the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. The first edition of the ICD did not include autism at all. The eighth (1967) edition mentioned only infantile autism as a form of schizophrenia and the ninth (1977) edition included it under the heading of ‘childhood psychosis’.
The 10th edition of the ICD (1992) and the third (1980), third revised (1987) and fourth (1994) editions of the DSM take the modern view that there is a spectrum of autistic conditions and that they are disorders of development, not ‘psychoses’.”

On page 29 of the same book, Wing details the reasons for this nosologic maelstrom:

“When an autistic disorder is diagnosed, there is the further problem of deciding which sub-group in the spectrum the individual belongs to. Now that the term Asperger’s syndrome is being used more widely, parents and professional workers as well, want to know how it differs from other forms of autism. Since Asperger’s group, unlike Kanner’s, includes mostly those of average or high levels of ability, the main question is how to tell Asperger’s syndrome from high-functioning Kanner’s autism. There is no simple answer.” Because as she establishes further, while some individuals present all the features of either, other individuals fit neither of these symptoms precisely, having (as myself…) mixtures of features of both.

And we haven’t even touched the serious problem of symptomatic and existential gender differentials, which is becoming more and more obvious, at least for the individuals on the autistic spectrum, because for the diagnostic and assessment services (at least in the UK, in my understanding) the primary diagnostic differentials are only age related. However, the UK’s NAS (The National Autistic Society) proves a genuine awareness of the necessity for further research at http://www.autism.org.uk/about/what-is/gender.aspx

To make things even more confusing, the DSM-5 published in May 2013, factually canceled Asperger’s as a separate diagnosis and included it as an autism spectrum disorder, with adjacent severity stages. It mentions nevertheless, that “Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.”

But if one may think that the ICD-10 is of any better clarity, a quick look at its ‘F84.5 Asperger syndrome’ entry, reveals an opening statement which I would call at least seriously problematic: “A disorder of uncertain nosological validity“, as I’m not really sure that a standard international classification should be based on anything “uncertain”.

The reason for the rather thought-twisting title of this post, can be found in a well hidden -in plain sight- introductory statement, on an oddly placed (right after the front cover page, without obvious authorship or number) page of Uta Frith’s “Autism and Asperger syndrome” (2010) edited book, which opens its last phrase with the statement “Current opinion on Asperger syndrome and its relationship to autism is fraught with disagreement and hampered with ignorance”, followed nevertheless by the reassurance that the book “gives the first coherent account of Asperger syndrome as a distinct variant of autism …” I have insofar found the attempts to systematize Autism maelstrom-like, because as their aquatic correspondents, they absorb all concepts and definitions in their way, just to scatter them on devastated, more or less scientific ocean-floors, without seemingly ever considering that behind words and terminologies, are real-life human beings, suffering the oftentimes indifferent detachment of those we trust(ed) for a better life…

And this very statement would be exactly the conclusion-prelude to a series of open enquiries attempting to discover the adult, gender specific understanding of first of all, the most commonly and widely used autism screening tool, the Autism Quotient 50 (AQ-50). As an incentive for the reader’s personal consideration and most welcome comments, I am providing a link to a short scientific paper from the “Journal of Autism and Developmental Disorders, Vol. 31, No. 1, 2001” at http://docs.autismresearchcentre.com/papers/2001_BCetal_AQ.pdf

In my next post, I will attempt to offer for an even more personalized analysis and comments, the first ten (1 ÷ 10) questions of the AQ-50 autism screening questionnaire, in the hope of initiating a “real-life” and “Actually Autistic” blog-forum, where especially adults on the autistic spectrum can evaluate in a safe, anonymously confidential environment their gender specific, unique understanding of the relevance of these questions for their own screening and diagnostic assessments, in an atmosphere of non-belligerent acceptance, mutual respect, civilised ‘agreement to disagree’ attitude and constructive tolerance.

Most sincere apology to my readers and followers, and Word of Caution:

Having painfully learnt my lessons elsewhere, and in order to protect the emotional wellbeing and dignity of all well-meaning viewers and participants, all comments and replies henceforth, will be monitored and subject to approval. Therefore, if your comment and/or reply doesn’t show immediately, please be patient. But if your comment and/or reply doesn’t show at all, please rephrase!

Because no one shall be bullied or harassed in my own blogyard! 👾🤓

 

Photo credit: By Walter Baxter, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=33579199

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Stimming (Self-stimulatory Behaviour / Repetitive Stereotyped Activity) – 1

stimmers (2)

In her seminal book “The Autistic Spectrum” (1996), Lorna Wing, OBE, FRCPsych, described what she identified as Repetitive Stereotyped Activities, to be “the other side of the coin of impairment of imagination” (pg. 45). The Autistic community has come to embrace the term stimming (as the shortened form for self-stimulation), which unfortunately acknowledges only one of Wing’s identified types, the simple ones, as these activities were further categorized as simple and elaborate. As she explains, “the simplest forms of these activities involve repetitive sensations” such as:

-tasting

-smelling

-feeling or tapping or scratching different surfaces

-listening to mechanical noises

-staring at lights or shiny things

-twisting and turning hands or objects near the eyes

-staring at things from different angles

-switching lights on and off

-watching things spinning or self-spinning

Sometimes, especially when “someone has no other way of occupying themselves“, self-injury can become a repetitive behaviour.

As I mentioned in one of my previous articles, Stimming vs Fidgeting… I believe there is a fundamental difference between fidgeting and stimming, with stimming as a mainly autism-specific Repetitive Stereotyped Activity.

In an attempt to make this article more ‘user friendly’ I’ve photographed some of my favourite stimmers (a term I use and suggest instead of stim-toys), a small American-football and two different hand strengtheners, one of rubber and the other as a small mechanical contraption, with a fountain pen as a dimension guide.

First of all, allow me to explain why I suggest stimmers. One of the reasons is the unnecessary association with toys in general which automatically follows the use of stim-toys, and the other being an even more unnecessary association with ‘toys’ of a more ‘adult’ nature…

Secondly and probably unknown to many, the word stimmer means in German amongst others tuner, used to tune musical instruments.

Now, as I explained in my  Stimming vs Fidgeting… post, stimming is fundamentally different from fidgeting because it requires the individual’s dedicated attention, and somewhat similar to a tuner, it seems to help the individual tune their sensory, cognitive and behavioural functionality.

For example, you may notice in the picture of my stimmers, that due to their material structure, they have particular surfaces, some smooth and soft such as blue rubber strengthener, rough and soft such as the small brown ball, cold and smooth such as the metal coil, strong smooth such as some parts of the mechanical strengthener or strong and rough such as other parts of it.

One may think that these differences are negligible, which may be the case for fidgeting, but not for stimming, because -at least in my case- the surface structure follows a typical need which cannot be met by any structure, but only specific ones. When I use for example, the blue rubber stimmer, my four thumb opposing fingers automatically seek the comforting ‘feeling’ provided by the four small velvety depressions found on one of its sides, and while the thumb provides support, the other four fingers are becoming anything in between trumpet key dancers and Morse code transmitters, and the choreography is endless.

In an autistic’s hand, an object becomes an objective, an instrument which tunes the complex functionality of the autistic brain, with its unusual capacity to process sensory stimuli in more areas than the specialised neurotypical brains.

 

A next post will cover the Elaborate Repetitive Stereotyped Activity, or stimming…